By fostering an open source ecosystem around their joint iEHR, the DoD and VA are not only tapping into less expensive software and development, but also training industry on how to work with them, sparking innovation and, ultimately, reaping the rewards of those IT advancements.
Harris Healthcare Solutions works with the DoD and the VA and recently won a contract to manage the SOA piece of the iEHR puzzle. Government Health IT spoke with Harris president Jim Traficant about what the services approach enables the VA and DoD to accomplish, the “genius” vision of working with the open source community on a project so vast in scale and projects where the federal government has succeeded by using this model.
Q: Harris was awarded an $80 million contract to develop the SOA portion of the VA DoD joint iEHR – what will an SOA enable that the agencies could not otherwise manage?
A: When we look at where the DoD and VA are headed, joint is the answer. They need a common platform to do a better job on continuity of care as service members move from the DoD into the VA system. So the service-oriented architecture is foundational to that future state of an integrated electronic health record, and will be the architectural foundation upon which all of the other capabilities will be integrated.
Q: Is the SOA the entire integration layer? One of many pieces? How does that all work?
A: It will be the foundational piece, I don’t know if it will be the only piece. The SOA allows you to go to the application layer because you can plug into a common service bus and be vendor-agnostic, application-agnostic and you can future-proof the architecture so you’re no longer dependent on individual systems being tightly integrated with each other. Now they can be commonly integrated into the architectural SOA, and the SOA will handle the communications, from an infrastructure standpoint, between the applications.
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Then when you get up to the data layer and the UI, it allows you to bring that up to the screen and organize the data according to workflow. Harris is also doing single sign-on across the VA and DoD to make it possible for those applications to function as a common system so clinicians can enter into the architecture with a single log-in and then move between the applications with the information organized in the context of the patient, and according to workflow.
Q: Another thing the VA has talked about is deploying iEHR at two military health facilities in the next two years: San Antonio and Hampton Roads, Va.
A: And a lot of that will be applications, so we’ll see things like pharmacy, lab, electronic medical record and all of those things riding on top of this SOA architecture. There will be separate procurement and separate contracts around the tasking of those applications within the overall architecture the SOA framework undergirds.
Q: One of the aspects of iEHR is that open source components will be available via OSEHRA, will any SOA pieces be among those?
A: What we’re seeing is the DoD and VA want to take advantage of open source as much s they can – and that’s why it’s also part of the service-oriented architecture. We’ve got some COTS with IBM, we also have open source elements. The goal of this is that, if you look at it, over half the care provided for active-duty and retired service members comes from the private sector, so if we’re going to get to this transformation, it’s great that we’re connecting the enterprises, but there’s still more to be done. We’ve got to enable an ecosystem, an infrastructure, a collaboration between the government and the private sector so we can do full continuity of care, not only between the DoD and the VA, but also when patients go to their hometown hospital or physician and then come back into the VA so that information can flow. Open source is going to provide cost-effective solutions to enable this future state of continuity of care. I think it’s a great vision.
Q: And how does open source advance that vision?
A: I think there’s an opportunity for it to work much like what ONC did with the Nationwide Health Information Network. What we saw there was solutions created in the federal sector by the Federal Health Architecture were able to be adopted and embraced because they are standards-based and open and I think you’ll see a similar model coming to the OSEHRA effort and they will proliferate out into the industry. Once that happens, it enables the vendors to build solutions that will work in the federal space so the VA and DoD don’t have to build it from scratch and maintain these complex applications.
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Instead, they take advantage of the innovation going on in industry and have it integrated into a common architecture fueled by the SOA and also extended by this open source platform. I don’t think it’ll be substitute products in open source, what we’re going to see is enabling a framework codifying the standards coming out of HHS and pieces that will enable the future state of the designed and integrated architecture so that industry knows how to behave within the joint iEHR.
Q: Which is an interesting comparison, because there’s evidence that it’s working for the NwHIN in terms of the federal government creating some standards but also pragmatically not dictating that those are the only standards.
A: One of the things we’ve done, Harris has taken what we did at the national level integrating the federal health agencies, the largest creators of that information, like DoD, VA and Indian Health, we were able to connect with the biggest consumers, CDC, the National Cancer Institute, Social Security. Then we took that same software baseline – this is a model for the open source – and we moved it to the states. So Florida, Oregon, Texas, some other work with Kaiser Permanente, they’re leveraging this open source created at the federal level and then applying that out into industry and creating alignment with what’s going on at the national level all the way down into these health information exchanges. That’s critical to fuel the transformation for the country. What we’re looking for out of IT is not just taking a broken analog paper-based system and digitizing that – we want to have a connected framework so we can literally improve quality and take out cost and if we don’t build that we will have failed with an IT approach. The framework being espoused in the joint iEHR is enabling that desired future state.
Q: Regarding SOA and the iEHR, how long will it take to plug applications into the SOA?
A: What we’re going to get to, and I think the whole point of the iEHR, is that we can’t take five years because the technology is moving too fast and the costs are escalating too quickly, the demand is too great. We have to get to a solution that begins to deliver real value in a couple years.
Q: What impact do you foresee the iEHR having, not just on the EHR market but on healthcare overall? The DoD and VA consider themselves, taken together with 18 million patients, a force that can move markets.
A: With the amount of training that occurs in the VA setting, 90 percent of physicians that go through, as part of their training they’re going to work at a VA facility at some point. The capacity to work with information in an integrated clinical enterprise will set the expectation for what you should be able to do as they move into private enterprise. A lot of what the DoD and VA do tends to proceed the type of integration and systems that you’ll find in the private sector and this interoperability we’re creating between the enterprises, when you look at meaningful use stage 2, that’s what has to happen, you have to have connected care not just digitized care in order to receive the incentives. It’s critical as a nation to improve care while taking out costs, we cannot afford to keep going the way we are. It’s this kind of innovation, program execution, and I want to say enterprise architecture – this is the genius of this approach – is not solving problems business by business, region by region, or application by application. Instead they have a holistic view of the architecture, a common way of executing in terms of procurement, a clarity of the desired end state. The DoD and VA are going to set a model that the rest of the country is going to want to follow.
